Provider First Line Business Practice Location Address:
3315 S 23RD ST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-572-8684
Provider Business Practice Location Address Fax Number:
253-284-0450
Provider Enumeration Date:
07/02/2013